The Treatment of Inoperable Carcinoma of the Uterus by Application of Heat. Dr. J. F. Percy, Galesbury, Ill., in Surgery, Gynecology and Obstetrics, October, 1914, after proving that cancer cells are destroyed at a temperature of 122 to 131 degrees F., while normal tissues are not injured until the temperature reaches 132 to 140 degrees, has devised an electric heating iron and water-cooled speculum to apply the needed heat to the carcinomatous womb and maintain it from 10 to 20 minutes.

The method is not proposed except for inoperable cases, and in them encouraging results have been obtained. The danger is in a late break in one or more branches of the uterine or internal iliac arteries, and it may develop that they should be tied before the operation.

The Dangers of the Ophthalmic Tuberculin Test.

American Medicine, for Sept., 1914, contains a timely warning by Dr. Harry Friedenwald, Baltimore, Md., which, while not discounting the diagnostic value of this test, narrates some disquieting cases presenting two intense conjunctival reactions, edema of the lid, punctate hemorrhages, fibrinous membranes, phlyctenular keratitis, iritis, pannus, corneal-ulcer and various other lesions.

The article is peculiarly valuable in its detailed references to the literature which has accumulated, thus adding force to the warning.

It would seem that this test is too dangerous for employment by the general practitioner, although it need not be wholly dropped by the institutional specialist providing he exercises every

care.

Permit us to add that, in our own practice, three serious cases presented themselves in which the test had been made by competent specialists in tuberculosis. In seeking information from tuberculosis dispensaries, we have heard of other cases. Therefore, in view of the fact that there is no dearth of diagnostic reactions and clinical tests, it impresses us that the ophthalmic tuberculin test should be wholly dropped by all classes of physicians.-EDITOR.

A Study of Twilight Sleep.

After observing 150 labors under the Freiburg method, Dr. Jacob Heller, Brooklyn, reports in Medical Record, Nov. 7, 1914, that 131 delivered themselves spontaneously and 19 were artifically terminated, of which number only six urgently demanded the use of forceps.

Hemorrhage was about as usual in an equal number of cases; the second stage of labor was somewhat lengthened; in a few women there was restlessness; none of the children were still-born, that is, failed of resuscitation. Three children died within a short time after birth, though they might have died under ordinary circumstances. Pituitrin was used in a number of cases. In general, results were as follows:

In 122 cases, or 81.3 per cent., we succeeded in obtaining a complete amnesia and an almost equal degree of analgesia. All that occurred during the time the patient was under the influence of the drugs, was wiped out of her memory. In 13. or 8.7 per cent., we got analgesia without amnesia. These were started somewhat too late. Gauss thinks that the ideal case is one in which

amnesia is complete. In our opinion, amnesia, while present in the great majority of cases, is not essential. The analgesia case without amnesia seems to us the more ideal, for not only does that labor appear more natural, but the patient can make good use of her abdominal muscles to shorten the duration of her labor.

In 15 cases, or in 10 per cent., we failed to obtain any marked results. With our present experience it is quite possible to reduce the number of failures to a smaller figure, but since the sensitiveness of the nervous system varies in different individuals, as does the susceptiblity to drugs, there will always be some cases that will not be influenced by the drugs unless carried beyond the point of safety.

Heroin for the Relief of Labor Pains. Dr. M. W. Kapp, San Jose, Cal., in Medical Record, November 14, 1914, says:

When I am called to a woman in labor and I am sure that the pains are real labor pains, I wait until the expectant mother shows some signs of distress, if it is a first confinement. That is so she may know what labor pains really are. If it is a case of a mother who has had one or more children, I do not wait for the pains to become even severe. I am presuming that the patient has been properly prepared for accouchment. I then give the patient (1-12) one-twelfth grain of heroin hydrochloride hypodermically. Within twenty minutes she will feel drowsy and no longer feel the sting of the pains.

At this time I sit down by the patient and explain to her the need of her bearing down when she feels the contractions. Between pains she will often fall into a light sleep. When I find she is progressing nicely I often go away and make a call or two, or at night I may lie down for an hour, leaving a nurse or someone with the patient who will call me if I am needed. If labor is getting well advanced I stay by the patient's side and watch every advance carefully.

The effect of one injection of one-twelfth grain heroin usually lasts about three hours. Some very severe cases need more heroin before the end of three hours. I simply watch my patient and if the pains are getting severe again I sometimes give another full dose. Again I may give only one twenty-fourth or one thirty-sixth of a grain. I aim never to have more than onetwelfth of a grain of heroin in action at one time. I have found that one-twelfth of a grain is the best average dose. I tried one-sixth of a grain several times and it spoiled my case by retarding the pains. One-twelfth grain inhibits the sensory nerves but does not affect the motor nerves. I have used as high as three and onehalf doses in one case. I rarely need more than one or two doses (1-12 to 7-24 grain).

I have used it in about one hundred cases, all in general practice. I have no trouble with the babies being blue, at least no more than I ever have had. Any long case of labor may cause a Ichild to be exhausted when born.

Heroin properly administered will hasten labor rather than retard it. It lightens pain so the mother if properly directed will aid in the expelling of the child. The use of morphine and scopolamine will retard labor almost every time. I have had no severe cases of hemorrhage while using heroin.

The mother usually rests very quietly after

labor and has much less shock than by the old method. Many doctors seem not to appreciate the condition of shock after labor. I have sometimes used a little chloroform at the last part of labor, but that is not necessary if the heroin has been properly managed.

I have had a few cases of inertia of the uterine muscles in which heroin did not seem to do much good, but by using divided doses of pituitrin labor was properly completed.

I do not claim that my methods and my technique are the best or are correct. I write this so that others who have better facilities to develop the correct method may be urged to do so. It is by far the best method of lessening the fear and pain of the lying-in chamber that I have ever been able to find and, best of all, I can use it in my general practice without fear.

The Freiburg method and the nitrous oxide and oxygen methods are good, but they are only to be used in hospitals. I believe that if heroin were used with the same technique as the morphine and scopolamine treatment, the results would be equal, and there would be no danger involved.

Heroin is just as dangerous as is scopolamine, so be careful; but Dr. Kapp's plan impresses us as workable and presenting certain advantages. But we believe it to be dangerous to give ether or chloroform in addition to the heroin. If the case promises to be a forceps delivery, allow the drug influence to subside somewhat before a general anesthetic is used.-EDITOR.

The Treatment of the Youthful Insane.

If one asks today, what can be done for the insane youth? we must bow our heads and answer, "Not a thing." When the diagnosis is made, so far as medicine is concerned, the patient is irrevocably lost. Our science, having no knowledge of the natural history of the disease, offers no help. The institutions for the insane report, after seven years of custody, only one recovery out of each 1,500 admissions. If we are asked, What can be done to prevent the disease? we must assert with equal humility our absolute helplessness. Since the causes of this disease are entirely unknown, we have no measures by which the influence of any one of them may be modified. This is a pitiable condition of ignorance on the part of our science, and this condition is due to the fact that no adequate researches have been made into the physical conditions of the insane, and no concerted and proportionate effort has ever been undertaken to discover the causes of insanity.

Toward the close of 1912, Halvar Lundvall published his first report on the use of the nucleate of soda in the production of a hyperleucocytosis for the treatment of dementia preCOX. He secured great improvement in most cases of dementia precox and absolute recovery in more than 20 per cent. of the patients under his care by keeping the leucocytes above 15,000. This remedy should not be neglected and it should be combined with all other means of promoting hyperleucocytosis and increasing the excretory power of the skin and mucous membranes.

The remedy consists of the following material, and can be furnished by Mr. L. Brickwoldt, of Sargent's drug store, 23 North Wabash avenue,

Chicago, or by any pharmacist having the ingredients.

Quassini depurati sicci, Gm. 2.0;

Aquæ destillatæ, Cc. 50.0.

Boil in a water-bath for one and a half hours, filter, and add,

Hetoli (i. e. sodii cinnamati), Gm. 1.0;
Sodii nucleinati, Gm. 10.0;

Acidi arsenosi (in soultion), Gm. 0.005.
Boil until all is dissolved, filter, and add,

Aquæ destillatæ bullientis, q. s. ut fiat Cc. 50.0. This remedy keeps perfectly. It does not produce abscesses or much pain. It raises the leucocytes from 8,000 to 25,000 within three hours when injected in 2 to 20 ccm. into the subcutaneous tissues.-Dr. Bayard Holmes, Chicago, in American Medicine, August, 1914.

Mineral Oil in Gastrointestinal Ulcers.

Paraffin oil, one-half ounce three hours after meals and late in the evening, is advocated by A. L. Benedict, in Amer. Jour. of Gastroenterology, as a lubricant in various supposedly malignant diseases of the digestive tract. The oil is also an excellent menstruum for carrying into the bowel bismuth, camphor, menthol and other medicaments.

Study up tropical diseases; the Panama Canal will bring them to us.

A German medical friend tells us it will be "an awful thing for American medicine if the Allies win." It surely will be! Just think of the English, French, Russian and East Indian synthetics and proprietaries we will then have to study up! And Japan, what of her? But we desist. The outlook is truly terrible!

Suppose the Latin races and the Greeks line up against Germany, and Germany wins, and the linguistic boycott goes merrily on, not only will geography have to be learned over, but what a jolly lot of new disease and medicine names we will have to study all over again! Dunder und blitzen!

The new British Pharmacopeia gives all formulæ in the metric system, but doses in the old and new systems, side-stepping as to what doses should be and putting it up to the individual prescriber and pharmacist, principally the latter. Indian and Colonial drugs are given some recognition, including betel leaves. The Prescriber, of England, thinks chewing gum and cigarettes have as much claim to recognition. Adrenalin, phenolphthalein, resorcin and a number of other additions are made, veronal being called "barbitone," whatever that means. But the British "hexamine" is better than our own hexamethylenamina, and their simple ointment is an improvement upon ours. There is shown a tendency towards international uniformity and the standardization of all potent vegetable drugs, which is to be much commended.

Doctor, you will never know how small a dollar looks until after you have gone all over this issue and noted how much of real help you find in it; then multiply that by twelve issues-all for one little dollar.

J. J. TAYLOR, M.D.

FOUNDER

THOS. S. BLAIR, M.D.

Ο

EDITOR

FEBRUARY, 1915 VOL. XX.

N MARCH FIRST, 1915, this law goes into effect. After full hearing of all interests involved, amendment and attempted amendment, this, the third Harrison Bill, finally was passed December 10, 1914, and signed by President Wilson December 18, 1914.

Physicians, druggists and officials who have interested themselves in the progress of the several bills unite in the belief that this is a piece of constructive legislation.

Drawn as an internal revenue measure and carrying a special tax feature, the question of States' rights is avoided, and it applies to all persons having to do with the distribution of opium or coca leaves their salts, derivatives or preparations. course this includes all physicians. Certain exemptions apply, inclusive of employees of physicians.

Of

Physicians will be obliged to take out a license costing one dollar from the internal revenue authorities, receiving certain order blanks. A physician may not purchase any of the interdicted substances except upon the presentation to the person or firm from whom he purchases one of these blanks properly filled. A licensed physician may prescribe or dispense these agents without additional record to persons upon whom he is in actual attendance, but he must keep a written record of any other distribution of these drugs.

Internal revenue collectors of any district may have free access to physicians' records of purchases and distribution. This will be no hardship to any physician who obeys the law, but it will afford a means for tracing distribution and will bring well-merited penalties to the physician who, either from selfish love of illegal gain or easy-going pandering to the spread of the drug habit, disobeys this righteous law, which does not interfere in the least with the proper practice of medicine.

At the time this was written the regula

No. 2

tions for the enforcement of the law have

not been issued; they will answer questions which may arise regarding methods of procedure.

Association, December 26, 1914, printed the The Journal of the American Medical following very clear abstract of the law: Explanation of the Bill.

The title of the act is "An Act to provide for the registration of, with collectors of internal revenue, and to impose a special tax upon all persons who produce, import, manufacture, compound, deal in, dispense, sell, distribute or give away, opium or coca leaves, their salts, derivatives or preparations and for other purposes."

Section 1 provides that after March 1, 1915, every person who performs any of the acts mentioned in the title shall register with the collector of internal revenue of the district his name and place of business, and shall pay a special tax of one dollar a year. Employees of registered persons, officers of the United States government, lawfully engaged in purchasing the drugs named for the army, navy, public health service or government hospitals and prisons are exempt. Only registered persons shall be permitted to perform any of the acts mentioned in the title. The term "person" is expressly defined to include partnerships, associations, companies or corporations.

Such

Section 2 provides that no person shall sell, barter, exchange or give away any of the drugs mentioned except on a written order on a form issued by the Commissioner of Internal Revenue and supplied only to registered persons. orders shall be issued in duplicate, the original to be preserved by the person filling the order and the duplicate to be preserved by the person issuing it, for a period of two years, and kept so as to be accessible to inspection by any officer of the Treasury Department or of State, territorial, district and municipal officers. The exemptions under this section were the subject of the most prolonged discussion. As the bill finally passed, it provides that this section shall not apply to the dispensing or distribution of any of the drugs named to a patient by a physician, dentist or veterinary surgeon registered under the act in the course of his professional practice, provided that the physician, dentist, or veterinary surgeon shall keep a record of all such drugs dispensed or distributed, showing the amount, the date and the name and address of the patient, except such as may be dispensed or distributed to a patient on whom such physician, dentist or veterinary surgeon shall personally attend. This record is to be kept for a period of two years,

subject to inspection. The sale of any of the drugs mentioned, on a written prescription issued by a physician, dentist or veterinary surgeon, is also exempt, but the person filling the prescription is required to keep the prescription on file for a period of two years. The sale of drugs to foreign countries is exempt, subject to the regulations of the country importing them, as is also the sale of drugs to any properly authorized government officer or State, territorial, district, county or municipal official purchasing supplies for a public hospital or prison.

The Commissioner of Revenue is authorized to prepare suitable blanks to be sold to dealers, the price not to exceed one dollar per hundred, and the name of the purchaser using the blank is to be written or stamped on it by the Collector of Internal Revenue. No other persons are permitted to use the forms. Special provisions are made for the administration of the act in Porto Rico, the Philippine Islands and the Canal Zone.

Section 3 provides that all persons registered under the provisions of the act shall, whenever required to do so by the Collector of the district, make a full and correct statement on oath of the quantity of the drugs he has received and the names of the person from whom he has received them.

Section 4 prohibits any except registered persons from shipping or delivering any of the drugs mentioned in interstate commerce. Common carriers and employees are exempt.

Section 5 provides that duplicate orders and prescriptions shall be open to the inspection of all authorized agents of the Treasury Department and officers of any State, Territory or municipality. Certified copies of such statements can be secured on the payment of a suitable fee. No persons are permitted to disclose the information contained in the returns except in the matter designated above. Copies of the names of all persons listed in any district may be secured on payment of one dollar for each one hundred names.

Section 6 provides that the act shall not apply to preparations or remedies which do not contain more than 2 grains of opium or more than 4 grain of morphin or more than % grain of heroin or more than 1 grain of codein to the fluid ounce, or, in the case of solid preparations, to the avoirdupois ounce or to preparations for external use only, or to decocainized coca leaves or other preparations of coca leaves which do not contain cocain.

Section 7 provides that all existing laws for the collection of internal revenue taxes are to be applied to the special taxes imposed by this act.

Section 8 provides that the possession of any of the drugs mentioned on the part of any unregistered person shall be regarded as presumptive evidence of the violation of the law. Employees of registered persons, nurses under the supervision of registered physicians, physicians themselves registered under the act, proper officials, warehouse men holding possession of goods for registered persons and common carriers transporting such goods are exempt.

Section 9 provides a penalty of not more than $2,000 fine or imprisonment for not more than five years or both for violations of the act.

Section 10 authorizes the Commissioner of Internal Revenue to appoint such persons as may be necessary to carry out the provisions of the

act.

Section 11 appropriates $150,000 to make the act

effective and Section 12 provides that this act shall not be regarded as modifying the national Food and Drugs Act or the act of 1909, prohibiting the importation of opium.

The External Treatment of True
Pneumonia.

OPINIONS DIFFER, in this as in

other things; and these differences are very honest. Yet, looking back over a long practice and remembering that the mortality rate in pneumonia has not fallen, we are inclined to resurrect some long-forgotten methods of treatment. And we find they still work as of yore. What a fall to our scientific pride!

Up

In a former practice among the Pennsylvania Germans, the onion poultice was often encountered. Onions fried in lard were applied hot in the early stages of sthenic pneumonia. Please don't tell any one, but we still slip this in on the quiet every now and then. The pesky stuff seems to work. Of course it ought not to, but it does. Down among the Southern negroes, Scotch snuff sprinkled over a larded cloth is used when "de chist am tight." North, where people never heard of it, we can ask for a larded cloth and sprinkle the snuff over it without telling what the powder is. Don't leave it on too long. In Michigan we used to see the country people use ground lobelia seed the same way, and that seemed to do well. So we combined the two ideas, mixing one part of snuff with three of the lobelia and stirring into hot melted vaseline. This does admirable work. Keep the two mixed powders in a tin can, all ready to use when first called to a case. Heat the poultice over the stove or a lamp before applying. Out West some of the good old ladies mix the yolks of six eggs into a stiff paste with fine table salt, spreading upon a cloth wrung out of hot water, and applying in "chronic cold," as some of them call pneumonia. This is not of much. account in the early stages, but after solidification it really gives great comfort, especially if the eggs used are old enough to contain some sulphuretted hydrogen. Leave it on all day or all night. Now don't laugh at these things: try them first. Ordinary mixed-with-water poultices do more harm than good.

It has long been known that gauze saturated with hot glycerin is a good application, and proprietary interests combine the glycerin with kaolin. These "mud poultices"

have many advocates and some detractors. Nevertheless, the glycerin is a good thing. If you don't like the heavy kaolin, mix the glycerin with ground slippery-elm bark. The Eclectic interests put up a relaxing magma containing lobelia, tobacco and ipecac, with other less potent ingredients.

DRY CUPPING in the early stages of pneumonia, actually does relieve dyspnea, and the patient can lie down and go to sleep. Apply a dozen cups in your next case that is sitting up gasping for breath.

PNEUMONIA JACKETS, made of oiled silk covered on the inside with cotton batting, were formerly much in use, especially when turpentined vaseline was used as an application. Many patients are given much comfort by this plan of procedure, but the danger comes when the jacket is removed, for finally it becomes uncomfortable. We seldom use it except in persons who are very thin, where the poor, rib-marked chest has not sufficient natural covering, when we use two thicknesses of canton flannel or outing cloth, with no oiled silk and no messy applications. If applications are used, employ them before the jacket is

worn.

HEAT, in our opinion should, after the first day or two, be dry heat, never moist. The egg-and-salt poultice suggested has so little moisture that it is really no violation of this practice. The electric heating pad is the best way to obtain heat. In the absence of this, the hot salt-bag may be used.

Patients of weak constitution, the feeble, the anemic, and especially those where the surface is cold and the heart weak, require heat; cold is contraindicated. But don't apply heat between the shoulders; it intensifies the constriction of the arterioles.

COLD is adapted to robust persons, to sthenic cases with full strong pulse and continued hyperpyrexia. These persons stand the cold-air treatment, and it helps a great many of them. Cold applications in pneumonia dilate the surface capillaries, and over the praecordial region stimulate the heart. Ice cradling has almost gone out, but there are cases in which it is useful. Cradles are arranged over the patient in his bed, not covering the head or feet. Small pails filled with ice are attached to the arches of the cradles. All is covered with blankets and that with a rubber blanket. Temperature is readily regulated, and the method is not dangerous providing judgment is used. Cold packs are very debatable, tepid sponging, with alcohol following,

being safer. Methyl chloride, applied to the area of the nerve nearest to an especially painful area, produces cold and relieves pain to a marked degree, but be careful with it, as harm may result. Cold baths and extensive applications of ice we regard as dangerous practice.

Who Should Push Federal Medical
Licensure?

We have had a sufficient number of letters, and comments in other medical journals, to show that the ideas advanced in licensure are, in general, well received. But these pages regarding a form of national

most of the letters seem to have been written with the thought uppermost in mind that all that is necessary is the introduction of a bill into Congress.

As we see it, the matter is not nearly so simple. There is entirely too much loosejointed medical legislation, and no individual, not even an editor, is capable of drafting a bill such as a national licensure bill should be. Furthermore, merely introducing a bill at random would be a slap at the various State boards, which would be exceedingly unwise and would, very properly, be resented by them.

Until after the profession knows just what it wants, it will be far better to agitate this question with members of the atpresent-constituted State boards in the several States, and in the medical societies. If the question is pushed to the fore by doctors generally, the Federation of Medical State Examining Boards will take the matter up intelligently; but if there is no interest shown in the matter by the profession, of course the Federation will not take it up. So it is largely "up to" the doctors themselves.

If you read back over our editorials upon the matter, it will be very apparent that our thought, has been to start an agitation, not to design the final form of a bill to be introduced into Congress; and we made it clear that only by coöperation between State and Federal officials is it practicable to put any form of Federal licensure into effect. In any event, it will take time to crystallize medical and official sentiment; then can progress be made intelligently, and not until then.

So, Doctor, push this matter yourself, and induce others to push it. Get busy in your own State. If doctors generally do this, the State boards will interest them